<!DOCTYPE html>
<html lang="zh" xmlns:th="http://www.thymeleaf.org" >
<head>
    <th:block th:include="include :: header('随访统计表修改')" />
</head>
<body>
<div class="ui-layout-center">
    <form id="form-SDtpSjdcFollowUpStatistics-edit" class="customize-search-form">

        <div class="customize-form-group-container">
            <input type="hidden" id="id" name="id" th:value="${id}">
                    <div class="customize-form-group">
                            <label>跟进人:</label>
                        <input name="follower" placeholder="跟进人" th:value="${follower}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>年龄:</label>
                        <input name="age" placeholder="年龄" th:value="${age}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>性别:</label>
                        <input name="gender" placeholder="性别" th:value="${gender}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>适应症:</label>
                        <input name="indication" placeholder="适应症" th:value="${indication}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>不良反应:</label>
                        <input name="adverseReaction" placeholder="不良反应" th:value="${adverseReaction}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>用药状态:</label>
                        <input name="medicationStatus" placeholder="用药状态" th:value="${medicationStatus}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>配合度:</label>
                        <input name="cooperationLevel" placeholder="配合度" th:value="${cooperationLevel}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>永久停药:</label>
                        <input name="permanentDiscontinuation" placeholder="永久停药" th:value="${permanentDiscontinuation}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>暂停用药:</label>
                        <input name="temporarySuspension" placeholder="暂停用药" th:value="${temporarySuspension}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>既往治疗方案:</label>
                        <input name="previousTreatmentPlan" placeholder="既往治疗方案" th:value="${previousTreatmentPlan}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>目前治疗方案:</label>
                        <input name="currentTreatmentPlan" placeholder="目前治疗方案" th:value="${currentTreatmentPlan}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>生存期（天）:</label>
                        <input name="survivalPeriod" placeholder="生存期（天）" th:value="${survivalPeriod}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>药品通用名:</label>
                        <input name="genericName" placeholder="药品通用名" th:value="${genericName}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>患者数:</label>
                        <input name="patientCount" placeholder="患者数" th:value="${patientCount}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>任务数:</label>
                        <input name="taskCount" placeholder="任务数" th:value="${taskCount}" class="styled-input" type="text">
                    </div>
        </div>
    </form>
</div>
<div class="main-content">
    <div class="col-sm-offset-5 col-sm-10">
        <button type="button" class="btn btn-sm btn-primary" onclick="submitHandler()"><i class="fa fa-check"></i>保 存</button>&nbsp;
        <button type="button" class="btn btn-sm btn-danger" onclick="closeItem()"><i class="fa fa-reply-all"></i>关 闭 </button>
    </div>
</div>
<th:block th:include="include :: footer" />
</body>
</html>
<script>
    function submitHandler() {
        var prefix = ctx + "dtp/sdtpsjdcfollowupstatistics";
        if ($.validate.form()) {
            var data = $("#form-SDtpSjdcFollowUpStatistics-edit").serializeArray();
            $.operate.saveTab(prefix + "/sDtpSjdcFollowUpStatisticsEdit", data);
        }
    }
</script>
